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Strengthen the Evidence for Maternal and Child Health Programs

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Practice-Focused Tools

MCH Best LogoThe third component of the Evidence Framework calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. This strengths-based approach draws on implementation tools designed for MCH populations. Use this page to access specific approaches and tools that the Evidence Center uses through our Ready, Set, Go approach.

1. READY: Learn how to implement projects that improve health outcomes.

Videos. Hexagon Discussion and Analysis Tool. This planning and evaluation tool guides the selection of appropriate, evidence-based strategies through a six-step exploration process. It can be used in collaboration with your partners to better understand how a new or existing program fits into your existing work, context, and goals for improving health outcomes.

The Hexagon Tool can be used at any point as you are implementing a program to determine its "fit" with the local context. Will this program work in your department along with all the other work that you're doing? Will it have an effect on the population as a whole? Will it help improve health outcomes for all populations? It is most commonly used during the period when your team is identifying possible new programs or practices to implement (the "exploration phase.")

More About the Hexagon Tool

The Hexagon Tool can at first seem complicated. But these are the basic questions it's asking.

Questions to ask about the program you're thinking about implementing:

  1. Evidence. Is the program based on good science? Does it appear to have impact with key population groups? Are the outcomes big enough to be "worth it" to try the program?
  2. Usability. Has the program been used in different settings with positive results? Can you find examples of other groups who have successfully implemented the program?
  3. Support. Does your department have enough staffing to do this program? Do you have resources to train staff in how to implement the program? Do you have a data infrastructure in place to measure results?

Questions to ask about your team and the surrounding work infrastructure:

  1. Need. What does the community feel the need is? Does the program address a gap? Is there data to show that this program can address the need? If implemented, what can potentially change for this population?
  2. Fit. How does the program fit within your current work scope and alongside other initiatives? How would it fit with community values?
  3. Capacity. Can we cover program costs? Can we collect and use data for ongoing monitoring and improvement?

How to Use the Hexagon Tool

How to Use

Prior to Using

  1. Identify the program or practice to be assessed.
  2. Review the discussion questions prior to meeting to ensure any data or resources that need to be reviewed for this discussion are available. If appropriate, an organization may prioritize components for deeper exploration based on the context and potential programs or practices.
  3. Identify a team to participate in the discussion. If the site has an Implementation Team, that team can complete the assessment as part of their work. If not, identify key stakeholders internal and external to the organization who have important diverse perspectives on the need and possible programs or practices. Suggested team members include leaders, managers, direct practitioners and consumers or community members.

During Use

  1. The team should review and discuss the questions for each indicator and document relevant considerations. Extra space is included in each section for notes and additional questions identified by the team to address unique needs and contexts.
  2. After discussing each component, the team rates the component using the 5-point Likert scale in each section.
  3. Using the discussion notes and ratings, the team makes recommendations about whether to adopt, replicate, or de-implement the program or practice. While ratings should be taken into account during the decision-making process, the ratings alone should not be used to determine final recommendations.

2. SET: An evidence-based tool to bring about impact.

Tool. The MCH Evidence Center uses the IDEAS Impact Framework in work with Title V agencies to ensure that new and ongoing strategies have the greatest potential to affect ongoing, meaurable, and sustainable change. The Framework draws on decades of research to provide a evidence-based approach for program implementation. This framework was developed by the Center on the Developing Child, Harvard University. It provides a structure for effective program development by asking your team to Focus on IDEAS: Innovate to solve unmet challenges; Develop a clear and precise theory of change; Evaluate the theory of change; Adapt through fast-cycle iteration; and Scale promising practices.

The process consists of four parts: Work through these parts as you plan out a new strategy/program or review a current strategy/program to ensure effectiveness:

1. Program Development — Critical Questions: When developing a strategy/program, ask yourself:

  • What about the existing strategy/program works? If we understand the key ingredients of a strategy or program, we can replicate and/or adapt the effective components. Looking at a strategy through a health behavior theory identifies key ingredients. Here are several to consider:
  • How does it work? Being specific about the underlying mechanisms can help us increase the impact. Developing a logic model with program actions, targets, outcomes, and moderators allows you track the process from action to outcome.
  • For whom does it work, and for whom does it not work? When we know who is and is not responding, we can make targeted adaptations to improve outcomes. Think about the program life cycle:
  • In what contexts does it work? By evaluating the context in which a strategy is implemented, we can adapt it for other settings. The best way to ensure that a strategy is effective is to conduct a robust evaluation. The MCH Navigator’s Evaluation Spotlight provides trainings and resources related to the steps and standards for effective program evaluation.

2. Early Implementation — Guiding Principles: In early implementation of a strategy/program, use these concepts to increase impact:

  • Precision. Understand what a strategy entails so you can go beyond “does it work,” to “what about it works” and “for whom does it work.”
  • Fast-cycle iteration. Incorporate new ideas as you go – what is working and what is not working.
  • Shared learning. Create a mechanism to share learning about success and failures.
  • Co-creation. Bring together multiple parties to create a mutually valued outcome.

3. Full Development — Key Components: After a strategy/program has been established, your work is not done; use these key components to ensure ongoing impact:

  • Theory of Change. Similar to a logic model, make sure you can articulate what about a strategy/program is making it effective. You can use the IDEAS model which includes strategies, targets, outcomes, and moderators or use a more complicated logic model structure.
  • Evaluation. To verify that your strategy/program is having measuable and sustainable impact, devote time to conduct an evaluation. The evaluation should invistigate wheter the the theory of change is actually driving ongoing improvement. A powerful, but simple evaluation approach is the Kirkpatrick Model.
  • Ongoing Program Development. Enact changes, through fast-cycle iteration, identified by your evaluation to achieve greater impact at larger scale.

3. GO: Utilize these additional tools for successful program implementation.

These tools have been backed up by scientific study as effective models or supports to achieve impact at scale..

Adaptation Tool: A Five-Step Worksheet from CMS

Adapting a Program: Stoplight Model for Adaptation (AMCHP) This tool assists to identify, reflect on, and determine the potential impact of adaptations you are considering making of an evidence-based/informed program.

Family Engagement: A Systems Assessment Tool

Family Engagement Systems Assessment Tools (Family Voices). This assessment tool tracks family engagement in health care systems and created supporting materials to assist in the recruitment of and meaningful engagement with families to improve systems of care, programs, and policies. The toolkit includes the assessment tool, instructions, score sheet, and related resources. Also, check out these articles related to the family engagement and the development/use of the FESAT:

Hexagon Tool: A Six-Step Process

Hexagon Tool. This planning and evaluation tool guides the selection of the appropriate, evidence-based/informed strategies through a six-step exploration process. It can be used in collaboration with your partners to better understand how a new or existing program fits into your existing work and context. The Center for Implementation has a good summary of the tool.

Root-Cause Analysis: Fishbone Diagram

Root-Cause Analysis (RCA) is a structured facilitated team process to identify root causes of an event that resulted in an undesired outcome and develop corrective actions. The RCA process provides a way to identify breakdowns in processes and systems that contributed to the event and how to prevent future events. The purpose of an RCA is to find out what happened, why it happened, and determine what changes need to be made. Read more about RCA.

A cause and effect diagram, often called a Fishbone Diagram, can help in brainstorming to identify possible causes of a problem and in sorting ideas into useful categories. A fishbone diagram is a visual way to look at cause and effect.

Download an Interactive Fishbone Diagram, designed specifiaclly for MCH programs, for use in determining causes. This diagram is in PowerPoint format for easy group work.

Read more about Fishbone Diagrams from the Centers for Disease Control and Prevention.

Learn more about Fishbone Diagrams from the National MCH Workforce Development Center.

Systems Change: "The Water of Systems Change" Approach

The Water of Systems Change Action Learning Exercise from FSG Consulting is designed to help individuals think systematically about strategic transformation, explore underlying organizational dynamics, and determine how they and their organizations can pursue meaningful, structured improvements in a disciplined and holistic manner. The exercise is divided into three parts: Part I performs an external assessment of opportunities; Part II uses the same framework to consider internal conditions; Part III looks at “What to do next?”

Prior to engaging in this exercise, all participants are encouraged to read the article The Water of Systems Change by John Kania, Mark Kramer, and Peter Senge.

Need more help? Request technical assistance (TA).

We are eager to talk with you further about your ESMs. We provide TA that is customized to your needs and the time you have.

Addressing complex, systems-based issues is strengthened by a team approach. We collaborate with Evidence-Based Decision Making team of the National MCH Workforce Development Center to identify, develop, measure, and improve your ESMs.

We also collaborate with the Association of Maternal and Child Health Programs (AMCHP) to ensure that you have access to promising practices and tools from other Title V programs across the country. Finally, we coordinate with a wide array of MCHB-funded topical TA centers to make sure you have access to cutting-edge knowledge and resources from the experts.

SMARTIE TA: A StrategicApproach to Our Work

Specifically, we provide SMARTIE TA that leads to:

  • Sharp, Specific, and Systems-based ESMs. We help sharpen ESM goals to more fully advance NPM topics and utilize systems to sustain these strategies.
  • Measurable and Meaningful ESMs. We ensure that your ESMs are measurable and in line with related projects in other states and jurisdictions.
  • Actionable, Achievable, and Aligned ESMs. We ensure that your ESMs inform your actions, are aligned with your needs assessment, and flow from your State Action Plan.
  • Relevant and Research-based ESMs. We connect your ESMs with the published evidence, emerging promising practices, and what other states are currently doing.
  • Translatable, Targeted, and Time-phased ESMs. We engage your team in developing sustained approaches to address specific needs of your populations, including Children and Youth with Special Health Care Needs (CYSHCN).
  • Integrated ESMs. We focus on collaborative decision-making processes.
  • Evaluated ESMs.We systematically assess and validate the effectiveness of your strategies through comprehensive performance monitoring and data-driven analysis.

Read about our TA in our brochure | Read about how our TA promotes implementation science

How To Request TA: Three Easy Ways

It’s easy to connect with us. We work closely with regional project officers to provide the most appropriate assistance. You can:

  • Email us at [email protected] with specific questions or to set up a time to talk. We will get right back with you to get the process started.
  • Use our online form to choose from several different types of TA.
  • Talk with your regional project officer who will contact us to arrange for TA, either for your group individually or as part of a group Title V programs.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.